Immigration and Social Security Co-ordination (EU Withdrawal) Bill (Eighth sitting)

Eleanor Smith Excerpts

Thursday 28th February 2019 Public Bill Committees

[Stuart C. McDonald]

The hon. Gentleman makes an absolutely valid point.

I turn to amendment 37, which would prevent the Government from bringing into force those parts of the Bill that subject EEA nationals to the domestic immigration system until EEA and Swiss nationals with immigration permission are exempted from the NHS’s overseas visitors charges. This amendment would mean that all EU migrants with a visa, including temporary workers on short-term visas, are able to receive NHS services free at the point of care. That reflects the current situation of EU nationals living and working in the UK.

The White Paper indicates that EU migrants on short-term visas of 12 months will have no right to healthcare beyond emergency care, and skilled workers and their dependants will be required to pay the immigration health surcharge when making an immigration application to enter or remain in the UK. Good preventive healthcare plays a central role in maintaining a fit and healthy workforce, and the policy to exclude people on short-term visas from all healthcare beyond emergency care establishes a worrying precedent in excluding from NHS services migrants who are legally living and working in the UK.

Those on short-term visas are likely to be in lower-paid jobs and unable to pay for healthcare out of their own pockets. Requiring EU migrants on skilled worker visas and their dependants to pay the immigration health surcharge is unfair and will be cost-prohibitive for some. Payment of the surcharge, which is currently set at £400 per person per year with a discounted rate for students of £300 per year, must be made at the same time as an immigration application, and it has to cover the total cost for the duration of the visa and for all the people named on the application. A person applying for a two-and-a-half-year visa will incur a surcharge of £1,000, on top of any other immigration fees, and a family of four would be required to pay £8,100 for a visa for the same period.

For those on low incomes, the health surcharge will be cost-prohibitive. We are particularly concerned about the impact that the surcharge will have on EU migrants living in the UK when they come to renew their visa, and about the fact that large health surcharge payments will prevent those on low incomes from being able to renew their visa, causing them to lose their lawful stay in the UK. It is also of note that EU migrants who are employed—for example, those on short-term or skilled visas—will be contributing to the NHS through tax and national insurance payments and that, by being required to pay the health surcharge, they will in effect be being charged twice for healthcare.

For those reasons, I have also tabled new clause 42, which would remove the applicability of the health surcharge. The surcharge has doubled this year to what I regard as an unacceptably high level.

[Eleanor Smith (Wolverhampton South West) (Lab)]

I wish to speak to new clause 12, which states:

“Any EEA or Swiss national, or family member of an EEA or Swiss national, resident in the United Kingdom shall be deemed ordinarily resident for the purposes of section 175 of the National Health Service Act 2006.”

When charging for non-residents was first introduced under section 175, it was not meant to add excess costs for that group of people accessing our healthcare. In 2015, costs were introduced that started at £200 for most applicants and £150 for certain groups—for example, students. The fee has now doubled. That means that a family of four would have to pay about £1,000 each in IHS costs in addition to their visa costs.

I am pleased that the Minister confirmed in November that EU citizens who are resident in the UK before it leaves the European Union in March 2019 will not pay the charge, and that the Government have come to an agreement with Switzerland, Norway, Iceland and Liechtenstein that during the transition period their citizens’ rights will be protected. However, it is still unclear what will happen after the transition period has come to an end in 2021 or in the case of a no-deal scenario, After December 2020, a new visa system will be in place that could mean that EEA citizens and Swiss nationals have to pay the immigration health charge.

It seems to be forgotten that most of the EEA citizens and Swiss nationals in the UK are currently employed and are already paying for the NHS through their taxes. Extending the immigration health surcharge to them would mean that they were being charged double for NHS care, which would seem to me an unfair contribution.

That leads me to the issue of the NHS. More than 60,000 NHS workers are EU nationals and, without settled status, they could face the possibility of paying the increased surcharge as well as for their tier 2 work visa. The new system could add further pressures for the NHS, which is currently struggling to recruit the number of healthcare professionals needed to meet the country’s demand.

Labour’s intention is to level rights up, not down. We hope that, after a new immigration system applying to nationals from across the world is introduced, none will be required to pay these charges.

[Kate Green]

I wish to speak to amendment 37, which has my support, as do the new clauses in this group. I would like to say a few words about one particular aspect of NHS charging, which is in relation to maternity care. Under the current charging rules, non-urgent care must be paid for in advance, but “urgent” or “immediately necessary” care must be provided whether or not a person can pay in advance. The guidance from the Department of Health and Social Care and the statutory regulations make it clear that maternity care is to be regarded as immediately necessary, so it must not be refused or delayed if a woman is unable to pay in advance, although she will still be charged for it. However, because of confusion about the charging regime and misapplication of the rules, pregnant women who are not UK nationals have already been denied maternity care, told that they must pay in advance of receiving treatment or told that their appointments may be cancelled if they fail to pay. Extending the charging regime to EU nationals, including pregnant women, would multiply such injustices in a system that is already making serious mistakes.

Charges for NHS maternity care start at approximately £4,000 and can rise into the tens of thousands for more complex care for women or additional care for new babies. Those charges are significantly higher than what NHS trusts would normally be paid for providing such care, because the regulations require them to charge 150% of the relevant NHS tariff. In practice, the rules mean that some hospitals have sent bills demanding immediate payment of thousands of pounds from vulnerable post-partum women. Women have received letters threatening referral to debt collectors, local counter-fraud specialists or the Home Office; in one appalling case, a woman was issued a bill of almost £5,000 for treatment following a miscarriage.

Research by the charity Maternity Action has found that the charging regime has resulted in women avoiding essential antenatal care and missing appointments because they fear incurring a debt that they cannot pay or being reported to the Home Office. That includes women with health conditions that require effective management to protect the health of both mother and baby. Antenatal care is intended to pick up and treat problems as early as possible, increasing the chances of a safe and healthy birth. Missing midwifery appointments means that high blood pressure and gestational diabetes are left untreated, the window for HIV prophylaxis is missed and minor infections are allowed to develop into serious health conditions.

Migrant women who are entitled to free NHS care are also affected by charging policies. Maternity Action regularly encounters women, including EEA citizens, who have been wrongly assessed as chargeable and have received bills for their care. In some cases, the women affected by the rules have children and spouses who are British citizens. Surely that was not the intention of the policy.

In December, the royal colleges issued a joint statement calling on the Department to suspend the charging regulations pending a full independent review of their impact on individual and public health. The Royal College of Midwives has expressed

“enormous concern…that vulnerable women are missing out on essential…care.”

Given the harm that charging for NHS maternity care is already causing to women’s physical and mental health, the fact that many women are simply unable to repay bills, the clear lack of regard being given to children’s best interests, the risks to public health and the potential for the charging regime to be extended to all EEA nationals, is it not time to consider the arguments for immediately suspending all NHS charging for maternity care?